Over View on the implementation of Repackaging Training.

1. Over View on the implementation of Repackaging Training. By: Jennifer Phelps, LPN/QMHP Central Virginia Community Services

2. Review Objectives • BOP Guidelines • Re-Packaging Log • Labeling of pillboxes • Location where re-packaging can be done • Facilitate Discussion

3. Who has started the Repackaging process? How many CSB’s or BHA’s have implemented this process?

4. BOP Guidelines • Repackaging to assist the client to self administer drugs. • The program is NOT intended to teach or authorize an individual to administer medication. • Assisting with self-administration is different from administering the drug to the client.

5. BOP Guidelines • Delivery Process • “Deliver” – Handing or delivering the already – dispensed medication to the patient or patient;s agent. Delivery may be delegated by the person dispensing to other staff, including un-licensed staff. Completion of the Medication Administration training approved by the Board of Nursing is NOT required for staff who deliver medications.

6. Guidance on this point includes: • Generally, taking pills out of the consumer’s bottle or blister pack and handing them to the consumer for on-the-spot ingestion is considered “administration” and is NOT permitted.

7. Guidance on this point includes: • Handing the bottle or blister pack to the consumer, instructing or verbally prompting the consumer to take (I.e. self-administer) the medication, coaching the consumer through the steps to ensure compliance, and closely observing the consumer self-administer the medication all fall short of “administer” and are therefore permitted.

8. Guidance on this point includes: • Reading / reviewing written materials about medication effects and side effects, or asking questions to monitor possible side effects, are also NOT considered “administration”, hence are permitted. From Guidance for Community Service Boards

9. Repackaging of Medication • Repackaging Process • Repackaging involves taking a previously dispensed medication and transferring it to another container while maintaining specific items in the labeling of the new container.

10. The following must be labeled on the container. • The client’s first and last name • The name and 24 – hour contact information for the CSB or BHA. • Ex: Jane Doe • CVCSB –555-555-1212

11. Repackaging of Medication • Repackaging Process • Because dispensed drugs are packaged in blister packages, vials, or unit dose containers labeled with drug name, drug dose, frequency and client’s name, moving the medication from one container to another is considered repackaging and not dispensing.

12. Repackaging Process • Medication can be repackaged in a CSB or BHA program by individuals who have passed an approved medication repackaging training program.

13. Repackaging Requirements • The repackaging of a dispensed prescription drug order pursuant to § 54.1-3420.2 shall only be done at a CSB or BHA. • Repackaging should be under good lighting and the use magnifying lenses and or keep the medication bottles at eye level to improve the likelihood of proper interpretation of look-alike medication names.

14. Recordkeeping • A record of repackaging shall be made and maintained for one year from the date of repackaging and shall include the following: • a. Date of repackaging; • b. Name of client; • c. Prescription number of the originally dispensed prescription drug order;

15. Recordkeeping • d. Pharmacy name; • e. Drug name and strength; • f. Quantity of drug repackaged; and • g. Initials of the person performing the repackaging and verifying the accuracy of the repackaged drug container.

16. Recordkeeping • Any time a repackaged drug is initially given to a client, and upon any subsequent change in medication order, the client shall be provided written information about the name and strength of the medication and the direction for use. Such written information shall have been prepared by a pharmacy or by a nurse at the CSB or BHA.

17. Repackaging Log

18. Repackaging Requirements • The repackaging of dispensed prescription drugs shall be restricted to solid oral dosage forms and a maximum of a 14-day supply of drugs. • The drug container used for repackaging pursuant to this section shall bear a label containing the client’s first and last name, and name and 24-hour contact information for the CSB or BHA.

19. Repackaging Requirements • A clean, well-closed container that assists the client with self-administration shall be used when multiple doses of a repackaged drug are provided to the client at one time.  Medication pill boxes must be wiped with alcohol pads when reusing containers. See “Infection Control”

20. Retention and storage • Any portion of a client’s prescription drug order not placed into a container intended to assist with self-administration may be either given to the client or retained by the CSB or BHA for subsequent repackaging. If retained by the CSB or BHA, the remaining portion shall be stored within the board-approved drug storage location in the original labeled container, and shall only be used for the client for whom the drug was originally dispensed.

21. Retention and storage • Any portion of a prescription drug order remaining at the CSB or BHA that has exceeded any labeled expiration date or one year from the original pharmacy dispensing date on the label shall be separated from unexpired drugs, stored within a designated area of the board-approved drug storage location, and destroyed within 30 days of expiration with the written agreement of the client.  Remaining portions of discontinued prescription drug orders retained by the CSB or BHA shall also be separated from active stock and either returned to the client or destroyed within 30 days of discontinuance with the written agreement of the client.

22. Disclaimer • All of the information presented today can be found in the Medication Repackaging Guidance Document given out by the Virginia Association of Community Services Boards. • This is NOT a Training on Repackaging but an overview on how our program implemented this process.

23. Positive Points from this…. • Our clients have taken a more active role in self-administering their medications. • Clients have commented they feel more pride in taking ownership in being more responsible for their medications. • We have more clients than ever now handling their medications and filling their weekly pillboxes.

24. Negative points… • Not all clients have adapted to the system. • Keeping pill boxes labeled properly is an on-going issue. • Clients normally do not have money for a pillbox, and have lost a few of them. • Not having meds when needed for filling the pillbox d/t nurses not having more direct involvement in the re-order process.

25. Discussion • Joyce let me tell you what they have us doing NOW! • (insert comic relief!)

26. Resources used for this presentation. More information can be found on the Virginia Board of Pharmacy Website, at http://www.dhp.state.va.us/pharmacy/.